Trinity Home Health of Southern Arkansas, LLC

“Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This Standard is not met as evidenced by: Based on observations during home visits, Agency Personnel interview, review of Agency’s Policy for PICC (Peripherally Inserted Central Catheter used to administer medications and fluids) care, review of literature from the Centers for Disease Control guidelines (CDC), the National Institute of Health guidelines (NIH), and manufacturers guidelines, the Skilled Nurse (SN) failed to follow accepted professional standards for infection control in 1 (#1) of 4 home visits observed. This failed practice had the potential to place the patient at risk for infection and rehospitalization. The deficient practice identified, if continued, potentially placed all patients with PICC or other venous access at risk of adverse outcomes and rehospitalization. During a home visit on 4/16/24 at 8:45 AM, the surveyor observed Patient #1 with a transparent dressing with a 2x2 gauze underneath covering a PICC insertion site of the right upper arm.. A review of CDC standards shows all persons over the age of 18 should have a Biopatch (a round hydrophilic wound dressing used to absorb exudate and to cover a wound caused by the use of vascular and non-vascular percutaneous medical devices such as: IV catheters, central venous lines, arterial catheters, dialysis catheters, it is impregnated with a powerful antimicrobial or anti infective chlorhexidine to decrease or eliminate bacteria at the insertion site and is left in place up to seven days.) During the home visit, the Skilled Nurse (SN) providing care to Patient #1 stated, “I wont change the dressing today. It was completed over the weekend by the on-call nurse.” Surveyor requested Agency policy for PICC dressing changes and was given a document titled “Vital Care Inc. Adult Catheter Care Guide (2008)”. The document Shows a PICC dressing with gauze should be changed every 48 hours or PRN (as needed). According to (CDC) Centers for Disease Control standards to reduce infection, a gauze dressing should be changed every 48 hours or sooner if needed to prevent infection. https://www.cdc.gov/infectioncontrol/pdf/guidelines/bsi-guidelines-H.pdf page 12. the CDC has created a checklist document with the same information at https://www.cdc.gov/hai/pdfs/bsi/checklist-for-clabsi.pdf. The standard was cross referenced with the National Institute of Health (NIH),which states that, “No more than 48 hours for use of a gauze sponge over a PICC insertion site.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3106267/ Clinical Record Review revealed the following: A visit note dated 4/14/42024 at 9:40 AM, documented a dressing change to PICC site. A visit note dated 4/16/24 at 6:23 AM reveals its a late entry for 4/15/24, “No dressing change performed today due to being changed on Saturday by weekend RN.” A visit note dated 4/16/24 at 4:25 PM documented, “No dressing change performed today due to being changed on Saturday by weekend RN.” During an interview on 4/17/24 at 1:53 PM, Agency Personnel #2 stated, “I didn’t know a gauze dressing couldn’t stay on for more than 48 hours on a PICC site. Its covered by a tegaderm”. (a transparent, semipermeable adhesive sheet). On 4/17/24 at 2:01 PM, Surveyor asked Agency Personnel #1 if there was a textbook or a guide the Agency used for nursing procedures and basic nursing practice, surveyor was told “No. We don’t have anything like that.””

“A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This Element is not met as evidenced by: Based on Clinical record review and staff interviews, it was determined the Agency failed to assure Oxygen (O2) was included in the review of all patient medications in 1 (#8) of 10 (#1-#10) Clinical Records reviewed. This failed practice by the Agency posed a risk of potential harm for patients on census receiving Oxygen therapy by inhibiting the Nurse and Physician’s ability to make informed decisions regarding the patients medication regimen related to potential adverse effects, drug reactions, significant side effects or significant drug interactions. A review of Clinical Record #8 revealed a document titled “Medication Profile” listing “Oxygen 2L (Liters) concentrate; Inhale 2 liters intranasally Continuous for supplemental”. During an interview, Agency Staff #1 was asked to show proof of medications being reconciled. After printing off the reconciliation list, it was determined the Agencies electronic medical record (EMS) system did not check for O2 interaction with Amiodarone (a medication administered for irregular heart rhythms that is one of two drugs known to interact with oxygen) also listed as part of the medication regimen. Agency staff #1 stated, “We just trusted it will check everything but it did not show an interaction between O2 and Amiodarone that was faxed to the physician for approval. According to Drugs.com, (a website used to check drug interactions), using “ Amiodarone and oxygen can increase the risk of adult respiratory distress syndrome (ARDS). ARDS can cause shortness of breath, rapid breathing and low oxygen.” There was no evidence interactions were checked against oxygen.”